Diagnostic considerations of tumors of the sellar region according to their geometry and vector growth.

Abstract

Introduction: Sellar and parasellar tumors are frequent lesions in neurosurgical practice, highlighting pituitary adenomas, craniopharyngiomas, and sellar tubercle meningiomas. The clinical manifestations are similar, however; There are imaging aspects that differentiate them.

Objective: Show imaging aspects of tumors in the sellar and parasellar region that guide their histopathological diagnosis.

Method: A descriptive, longitudinal and prospective study was carried out that included 200 patients from the Hermanos Ameijeiras Hospital, of which 120 had a histopathological diagnosis of pituitary adenoma, 50 of craniopharyngioma and 30 of sellar tubercle meningioma. The variations in the displacement of the point of the anterior communicating arterial complex and in the premammillary angle were analyzed by means of a cerebral nuclear magnetic resonance study. For data analysis, absolute and relative frequencies were used as summary measures.

Results: A cephalic displacement of the anterior communicating arterial complex was evident in the craniopharyngiomas, of 10-11.9 mm (84.0 %); in pituitary macroadenomas, 12-14 mm (78.3%); and in sellar tubercle meningioma, ≥14 (86.6 %) mm. When evaluating the premammillary angle, pituitary adenomas were identified between 85º and 95º (73.3 %); in craniopharyngiomas, <85º (90.0 %); and in meningiomas of the sellar tubercle, between 85 and 95º (86.6 %).

Conclusions: The present study allows us to identify imaging characteristics in sellar and parasellar tumors that guide with high certainty the histopathological diagnosis and thus establish a more effective treatment.